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首页> 外文期刊>Journal of Hand Surgery. American Volume >Acellular dermal regeneration template for soft tissue reconstruction of the digits.
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Acellular dermal regeneration template for soft tissue reconstruction of the digits.

机译：用于手指软组织重建的无细胞真皮再生模板。

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PURPOSE: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects. METHODS: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had exposed bone, 8 digits had exposed tendon, 6 digits had exposed joints, and 2 digits had exposed hardware. The acellular dermal regeneration template was sutured over the soft tissue defect. Over 3 weeks, a neodermis formed. The superficial silicone layer of the acellular dermal regeneration template was removed, and the digits received full-thickness epidermal autografting with cotton bolster. RESULTS: The duration of postoperative follow-up extended to a minimum of 12 months. For the injury sites where acellular dermal regeneration template was applied, the total area of application ranged from 1 cm(2) to 24 cm(2), with the largest individual site measuring 12 cm(2). Twenty of 21 digits demonstrated 100% incorporation of the acellular dermal regeneration template skin substitute. One digit that had sustained multilevel trauma developed necrosis requiring revision amputation. Full-thickness epidermal autografting was performed an average of 24 days after acellular dermal regeneration template skin substitute application and demonstrated a 100% take in 16 of 20 digits and partial graft loss of 15% to 25% in 4 of 20 digits that did not require further treatment. CONCLUSIONS: Acellular dermal regeneration template combined with secondary full-thickness skin grafting is an effective method of skin reconstruction in complex digital injuries with soft tissue defects involving exposed bone, tendon, and joint. The neodermis increases tissue bulk and facilitates epidermal autografting with digital injuries that otherwise would require flap coverage or skeletal shortening of the digit. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
机译：目的：手指外伤经常使软组织缺损，骨骼，关节和/或肌腱裸露，需要进行软组织置换。这项研究的目的是评估脱细胞真皮再生模板结合全厚度皮肤移植在软组织缺损的数字损伤中对软组织重建的有效性。方法：使用脱细胞皮肤再生模板重建具有暴露的骨，关节，腱和/或硬件的数字损伤，这些损伤不适合通过次要目的，旋转皮瓣或原发皮肤移植进行愈合。将无细胞真皮再生模板应用于17位患者的21位数字。 19位手指暴露了骨骼，8位手指暴露了肌腱，6位手指暴露了关节，2位手指暴露了硬件。将脱细胞真皮再生模板缝合在软组织缺损上。在3周内，形成了一个新真皮。去除无细胞真皮再生模板的表层硅酮层，并用棉垫将指骨接受全厚度表皮自体移植。结果：术后随访时间延长至至少12个月。对于应用无细胞真皮再生模板的损伤部位，总应用面积为1 cm（2）至24 cm（2），最大的单个部位为12 cm（2）。 21位数字中的20位证明了无细胞真皮再生模板皮肤替代品的100％掺入。一位遭受多级创伤的手指出现了坏死，需要截肢。在应用脱细胞真皮再生模板皮肤替代品后平均24天进行全厚度表皮自体移植，并证明20位中的16位100％摄取了100位，而20位中的4位表明部分移植损失了15％至25％。进一步治疗。结论：脱细胞真皮再生模板与二次全层皮肤移植相结合是在复杂的数字损伤中发生的皮肤重建的有效方法，该损伤具有包括裸露的骨骼，腱和关节的软组织缺损。新真皮增加了组织的体积，并促进了表皮自体移植并造成手指损伤，否则将需要覆盖瓣或缩短手指的骨骼。研究类型/证据级别：治疗IV。

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